scholarly journals A Case of Supplement-Induced Hepatotoxicity

2010 ◽  
Vol 2010 ◽  
pp. 1-5 ◽  
Author(s):  
Fong-Kuei Frank Cheng ◽  
Peter Dunaway
Keyword(s):  
Abdominal Pain ◽  
Liver Disease ◽  
Liver Injury ◽  
Dietary Supplements ◽  
Medication Use ◽  
Over The Counter ◽  
Caucasian Male ◽  
History Of ◽  
One Year ◽  
Specific Agent

A 45-year-old Caucasian male presented with a two-week history of jaundice and right-upper quadrant (RUQ) abdominal pain. Transaminases and biliary enzymes were markedly elevated with hyperferritinemia and mildly elevated INR. Imaging tests showed no significant abnormality. He denied prescription or over-the-counter (OTC) medication use, but he had been taking at least 9 dietary supplements for 12 months. Other causes of liver disease were excluded. His supplements were discontinued, and his liver-associated enzymes significantly markedly improved over the next 6 weeks and remained normal after one year suggesting supplement-induced hepatotoxicity. Due to the number of supplements, no specific agent could be identified as the primary cause of his liver injury. This case illustrates the importance of inquiring and educating patients of the potential harmful risks of over-the-counter medications and supplements.

An unusual presentation of epigastric pain due to thrombophlebitis of a recanalised umbilical vein – case report

2019 ◽  
Vol 98 (8) ◽  
pp. 326-327 ◽  
Keyword(s):  
Liver Cirrhosis ◽  
Abdominal Pain ◽  
Case Report ◽  
Portal Hypertension ◽  
Liver Disease ◽  
Epigastric Pain ◽  
Umbilical Vein ◽  
History Of ◽  
Clinically Significant ◽  
Inflammatory Changes

Introduction: The umbilical vein can become recanalised due to portal hypertension in patients with liver cirrhosis but the condition is rarely clinically significant. Although bleeding from this enlarged vein is a known complication, the finding of thrombophlebitis has not been previously described. Case report: We report the case of a 62-year-old male with a history of liver cirrhosis due to alcoholic liver disease presenting to hospital with epigastric pain. A CT scan of the patient’s abdomen revealed a thrombus with surrounding inflammatory changes in a recanalised umbilical vein. The patient was managed conservatively and was discharged home the following day. Conclusion: Thrombophlebitis of a recanalised umbilical vein is a rare cause of abdominal pain in patients with liver cirrhosis.

scholarly journals Oriental Cholangiohepatitis in a Caucasian male

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110355
Author(s):  
Laura Suzanne K Suarez ◽  
Larnelle N Simms ◽  
Khaled Deeb ◽  
Curtis E Scott
Keyword(s):  
Abdominal Pain ◽  
South Korea ◽  
Southeast Asia ◽  
Biliary Decompression ◽  
Caucasian Male ◽  
Extensive Evaluation ◽  
Recurrent Pyogenic Cholangitis ◽  
History Of

Recurrent pyogenic cholangitis (RPC) is a condition found almost exclusively in individuals who lived in Southeast Asia. We report a case of a Caucasian veteran diagnosed with RPC after presenting with a 5-year history of recurrent fevers and abdominal pain 20 years after serving in Japan, South Korea, and Guam. Extensive evaluation led to the diagnosis of RPC with improvement after biliary decompression and antibiotics. Although rare, RPC should be considered in individuals who present with recurrent bouts of abdominal pain and fevers regardless of race.

scholarly journals Caspase-Cleaved Keratin 18 Measurements Identified Ongoing Liver Injury after Bariatric Surgery

2021 ◽  
Vol 10 (6) ◽  
pp. 1233
Author(s):  
Felix Hempel ◽  
Martin Roderfeld ◽  
Lucas John Müntnich ◽  
Jens Albrecht ◽  
Ziya Oruc ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Liver Disease ◽  
Liver Injury ◽  
Response To Treatment ◽  
Morbidly Obese ◽  
Alcoholic Fatty Liver ◽  
Laboratory Parameters ◽  
Nafld Fibrosis Score ◽  
Keratin 18 ◽  
One Year

Bariatric surgery has emerged as an effective treatment option in morbidly obese patients with non-alcoholic fatty liver disease (NAFLD). However, worsening or new onset of non-alcoholic steatohepatitis (NASH) and fibrosis have been observed. Caspase-cleaved keratin 18 (ccK18) has been established as a marker of hepatocyte apoptosis, a key event in NASH development. Thus, ccK18 measurements might be feasible to monitor bariatric surgery patients. Clinical data and laboratory parameters were collected from 39 patients undergoing laparoscopic Roux-en-Y gastric bypass at six timepoints, prior to surgery until one year after the procedure. ccK18 levels were measured and a high-throughput analysis of serum adipokines and cytokines was carried out. Half of the cohort’s patients (20/39) presented with ccK18 levels indicative of progressed liver disease. 21% had a NAFLD-fibrosis score greater than 0.676, suggesting significant fibrosis. One year after surgery, a mean weight loss of 36.87% was achieved. Six and twelve months after surgery, ccK18 fragments were significantly reduced compared to preoperative levels (p < 0.001). Yet nine patients did not show a decline in ccK18 levels ≥ 10% within one year postoperatively, which was considered a response to treatment. While no significant differences in laboratory parameters or ccK18 could be observed, they presented with a greater expression of leptin and fibrinogen before surgery. Consecutive ccK18 measurements monitored the resolution of NAFLD and identified non-responders to bariatric surgery with ongoing liver injury. Further studies are needed to elicit the pathological mechanisms in non-responders and study the potential of adipokines as prognostic markers.

scholarly journals Chronic Hepatitis C with Cyanosis

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Mahmood Alawainati ◽  
Jawad Khamis ◽  
Muneer Abdulla ◽  
Saeed Alsaeed
Keyword(s):  
Pulmonary Embolism ◽  
Chronic Hepatitis ◽  
Liver Disease ◽  
Hepatitis C ◽  
Liver Transplant ◽  
Chronic Hepatitis C ◽  
Hepatopulmonary Syndrome ◽  
History Of ◽  
Transplant Candidates ◽  
One Year

Background. There are multiple aetiologies for dyspnea in patients with liver disease, including pneumonia, pulmonary embolism, hepatic hydrothorax, portopulmonary syndrome, and hepatopulmonary syndrome. The aim of this paper is to emphasize the importance of early diagnosis and management of hepatopulmonary syndrome. Case Presentation. We report a case of a 65-year-old male who was known to have chronic hepatitis C presented with one-year history of shortness of breath and cyanosis. The initial impression of pulmonary embolism was excluded by comprehensive diagnostic investigations. The correlation between the clinical picture and investigations raised the possibility of hepatopulmonary syndrome which was confirmed by contrast-enhanced transthoracic echocardiography. Conclusions. High suspicion is required to diagnose hepatopulmonary syndrome in patients with liver disease and hypoxemia. Screening for this complication is appropriate in liver transplant candidates, and diagnosed patients should be evaluated extensively for liver transplant.

scholarly journals 84. Over-Utilization of Prehospital Rapid Blood Glucose Measurements

1996 ◽  
Vol 11 (S2) ◽  
pp. S48-S48
Author(s):  
Edward A. Michelson ◽  
Kenneth S. Pearlman
Keyword(s):  
Abdominal Pain ◽  
Blood Glucose ◽  
Test Performance ◽  
Urban Population ◽  
Altered Mental Status ◽  
Level Of Consciousness ◽  
History Of ◽  
One Year ◽  
Not At Risk

Purpose: Determination of rapid blood glucose (RGB) by colorimetric stick test aids in the prehospital identification and treatment of hypoglycemia. The test may be applied unnecessarily to patients not at risk for, and in clinical situations not associated with hypoglycemia. We attempted to estimate the rate of over-utilization of RGB in a large urban EMS setting.Methods: All run sheets during a one week period from 7 sites providing radio command to both city and private EMS units serving a large urban population were screened. Those runs including RGB determination were further classified for presence or absence of a test indication. RGB was considered indicated with history or finding of: altered mental status, decreased level of consciousness, seizure, syncope and near syncope, generalized weakness or dizziness, with or without a history of diabetes.Results: 613 RGB determinations were identified during one week (annual rate = 31,876). 371 (61%) met indication criteria for test performance, and 242 (39%) failed to meet criteria. The patient complaint in cases not meeting criteria included; cardiac - 80, respiratory distress - 66, trauma - 38, abdominal pain -15, burns - 12, OB - 8, CVA - 6. Moreover, among these patients fewer than half had a history of diabetes. If this rate of over-utilization were maintained for one year, in excess of 12,500 extra tests would be performed in this system.

scholarly journals Gastrointestinal Tolerability of Ibuprofen Compared with Paracetamol and Aspirin at Over-the-Counter Doses

2002 ◽  
Vol 30 (3) ◽  
pp. 301-308 ◽  
Author(s):  
P Rampal ◽  
N Moore ◽  
E Van Ganse ◽  
J-M Le Parc ◽  
R Wall ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Adverse Events ◽  
Over The Counter ◽  
Parallel Group Study ◽  
Parallel Group ◽  
Gastrointestinal Tolerability ◽  
History Of ◽  
The Difference ◽  
Better Than

This multicentre, randomized, investigator-blinded, parallel-group study compared the gastrointestinal (GI) tolerability of ibuprofen, paracetamol and aspirin at over-the-counter doses for common pain indications. Patients (of whom 8633 were evaluable) took either ibuprofen up to 1200 mg daily, or paracetamol or aspirin, each up to 3000 mg daily, for 1–7 days. The main outcome was the proportion of patients with GI adverse events. There were significantly more patients who suffered GI adverse events, principally abdominal pain, dyspepsia, nausea and diarrhoea, with aspirin (18.5%) than with ibuprofen (11.5%), but the difference between ibuprofen and paracetamol (13.1%) was not significant. Significantly more of those patients with a history of non-ulcer GI disease ( n = 371) developed GI adverse events than did those with no such history; the incidence of GI adverse events in both groups was lowest with ibuprofen. More women than men experienced GI adverse events (15.5% versus 12.8%). The higher incidence of GI adverse events with aspirin was evident from the first day of treatment. In conclusion, the GI tolerability of ibuprofen, at over-the-counter doses of up to 1200 mg daily for up to 7 days, was at least as good as that of paracetamol and significantly better than that of aspirin.

scholarly journals Lack of Clinical Relevance of ANA and ASMA Positivity in Patients with Liver Transplantation without a History of Autoimmune Diseases

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Lucienne Pellegrini ◽  
Gianpaolo Parrilli ◽  
Antonella Santonicola ◽  
Luigi Cinquanta ◽  
Cesare Caputo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
Autoimmune Disease ◽  
Liver Injury ◽  
Autoimmune Diseases ◽  
Clinical Relevance ◽  
Serum Antibody ◽  
History Of ◽  
One Year ◽  
The One

The relevance of isolated autoimmunity elevation in orthotopic liver transplantation (OLT) patients is unknown. Our aim was to analyse how serum autoantibodies change in time and to evaluate their clinical relevance in OLT patients. Patients were invited to provide samples to evaluate ANA, AMA, ASMA, and LKM at the time of enrolment (T0), after 6 months (T6), and after 12 months (T12). We included 114 patients in the study (76% males, median age 62.5 years), finding isolated elevation of at least one serum antibody in up to 80% of them. We described fluctuating positive autoantibodies in the one year of observation, with only 45.6% of patients positive for ANA and less than 2% positive for ASMA, at all three times. Isolated elevation of tissue antibodies was not related to gender, age, HCC at transplant, early rejection, cause of transplantation, immunotherapy taken, and age at the time of the study. We did not detect a higher prevalence of positive autoimmunity in patients with signs of liver injury. ANA and ASMA evaluation in patients with liver transplantation and no history of autoimmune disease has no clinical relevance, since it varies in time and is not related to any risk factors or liver injury. Routine autoimmunity evaluation should be avoided.

scholarly journals Animals Models of Gastrointestinal and Liver Diseases. Animal models of alcohol-induced liver disease: pathophysiology, translational relevance, and challenges

2014 ◽  
Vol 306 (10) ◽  
pp. G819-G823 ◽  
Author(s):  
Stephanie Mathews ◽  
Mingjiang Xu ◽  
Hua Wang ◽  
Adeline Bertola ◽  
Bin Gao
Keyword(s):  
Liver Disease ◽  
Liver Injury ◽  
Neutrophil Infiltration ◽  
Alcoholic Liver Injury ◽  
Drinking Patterns ◽  
Excessive Alcohol Consumption ◽  
Ethanol Feeding ◽  
History Of ◽  
Excessive Alcohol ◽  
Binge Ethanol

Over the last four decades, chronic ethanol feeding studies in rodents using either ad libitum feeding or intragastric infusion models have significantly enhanced our understanding of the pathogenesis of alcoholic liver disease (ALD). Recently, we developed a chronic plus binge alcohol feeding model in mice that is similar to the drinking patterns of many alcoholic hepatitis patients: a history of chronic drinking and recent excessive alcohol consumption. Chronic+binge ethanol feeding synergistically induced steatosis, liver injury, and neutrophil infiltration in mice, which may be useful for the study of early alcoholic liver injury and inflammation. Using this chronic+binge model, researchers have begun to identify novel mechanisms that participate in the pathogenesis of alcoholic liver injury, thereby revealing novel therapeutic targets. In this review article, we briefly discuss several mouse models of ALD with a focus on the chronic+binge ethanol feeding model.

Abstract P215: Sleep Medication and Incident Stroke: The REGARDS Study

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Megan E Petrov ◽  
Virginia J Howard ◽  
Dawn O Kleindorfer ◽  
Michael Grandner ◽  
Jennifer R Molano ◽  
...  
Keyword(s):  
Risk Factors ◽  
Racial Differences ◽  
Stroke Risk ◽  
Medication Use ◽  
Older Individuals ◽  
Vascular Events ◽  
Over The Counter ◽  
Sleep Medication ◽  
Increased Risk ◽  
History Of

Introduction: Preliminary evidence suggests sleep medications are associated with risk of vascular events; however, the long-term association with stroke risk is understudied. The aim of this study was to investigate the relation between sleep medication use and incident stroke. Methods: Within the REasons for Geographic And Racial Differences in Stroke study, 21,678 black and white participants (≥45 years) with no history of stroke were studied. Participants were recruited from 2003–2007. From 2008–2010, participants self-reported their prescription and over-the-counter sleep medication use over the past month. Suspected stroke events were identified on 6-month telephone contact, and associated medical records retrieved and physician adjudicated. Proportional hazards analysis was used to the estimate hazard ratios for incident stroke associated with sleeping medication use (0, 1–14, and 15+ days per month) controlling for sociodemographics, stroke risk factors, mental health symptoms, and sleep apnea risk. Results: At baseline, 9.6% of the sample used prescription sleep medication and 11.1% used over-the-counter sleep aids. Over an average follow-up of 3.3±1.0 years, 297 stroke events occurred. Over-the-counter sleeping medication use was associated (p = 0.014) with increased risk for incident stroke, with a 46% increased risk for use between 1 and 14 days a month (HR = 1.46; 95% CI: 0.99 - 2.15) and a 65% increased risk for use on 15 or more days (HR = 1.65; 95% CI: 0.96 - 2.85). There was no significant association with prescription sleep medications (p = 0.80). Discussion: Over-the-counter sleep medication use may independently increase the risk of stroke beyond other risk factors in middle-aged to older individuals with no history of stroke.

Beliefs about antidepressants among persons aged 70 years and older in treatment after a suicide attempt

2015 ◽  
Vol 27 (11) ◽  
pp. 1795-1803 ◽  
Author(s):  
Eva Lesén ◽  
Stefan Wiktorsson ◽  
Anders Carlsten ◽  
Margda Waern ◽  
Tove Hedenrud
Keyword(s):  
Suicide Attempt ◽  
Suicide Risk ◽  
Older Persons ◽  
Medication Use ◽  
Objective Measures ◽  
Psychiatric Evaluation ◽  
Prior History ◽  
History Of ◽  
One Year

ABSTRACTBackground:The use of antidepressants is associated with decreased suicide risk in late life, and these drugs are often prescribed after a suicide attempt. Yet little is known about attitudes to antidepressants in older persons with suicidal behavior. The aim of this study was to assess beliefs about antidepressant medicines in older persons in treatment one year after a suicide attempt.Methods:Forty-four individuals aged 70 years and older, who were treated in emergency wards at five hospitals in western Sweden in connection with a suicide attempt, were interviewed at index attempt and one year later. Beliefs about medicines questionnaire (BMQ) specific for antidepressants were analyzed one year after index attempt, in relation to sociodemographic variables, medication use, psychiatric evaluation, and personality traits.Results:The majority of participants perceived the necessity of their antidepressant medicine to outweigh their concerns. Lower perceived necessity of antidepressants was observed in those who were not on antidepressants at the time of the attempt as well as those with no prior history of suicide attempt before the index attempt. Individuals reporting hopelessness at follow-up had a higher perceived concern about using medication.Conclusions:Beliefs about antidepressants tended to be more positive than negative in older persons taking these drugs in the aftermath of a suicide attempt. Further studies are called for, and should include objective measures of medication adherence.

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